Doctors debate pay for organ donors
Cash would draw volunteers, some say
By Allison Sherry
Denver Post Medical Writer
Friday, June 14, 2002
Organ donors would have funeral and travel expenses partially paid for under a pilot study that promises to be one of the main issues at the American Medical Association convention, which begins today in Chicago.
Dr. Frank Riddick, chairman of the AMA's council of ethical and judicial affairs, said he's optimistic the study will be approved so doctors can learn whether those inducements would increase the number of organ donors. An average of 16 people a day nationwide die waiting for an organ.
Colorado donor officials, however, say they won't participate because they want donor families to make altruistic decisions rather than be persuaded by incentives.
"Some people think it's a bad idea, that it would cut down on organ donations. . . . That's why you study it," Riddick said.
An 18-year-old federal law bars organ donors from receiving cash gifts, allowing only some reimbursement for the donor family's hotels. The pilot project under consideration would require a waiver from the U.S. Department of Health and Human Services.
There are too many ambiguities for Colorado's Donor Alliance to endorse the measure, said Nikki Wheeler, spokeswoman for the alliance, which serves Colorado and Wyoming. The alliance hasn't budgeted any money for gifts to donor families, she said.
"There's nothing to say exactly how this is going to work," Wheeler said. "And what is the family's role in this? Would they be more concerned about the money?"
Doctors worry that a financial reward would unfairly tempt a poorer population. Would people begin to make decisions based on what they can afford rather than what they believe is right?
"Financial incentives may make the (cause) worse, not better," said Mark Boucek, a Children's Hospital cardiologist who performs pediatric transplants.
"To directly reward someone for giving up an organ for donation is not something most transplant surgeons support," he said.
Still, the number of people waiting for an organ has more than doubled in the last decade, creating pressure to increase the number of donors, even if it requires financial incentives.
"I know some would say, so what? We've got all these people dying on the waiting list," said Dr. Fred Grover, head of the cardio-thoracic surgery division at the University of Colorado Hospital.
The pilot program the AMA will discuss wouldn't provide cash to families of organ donors, but the families would get $300 to $500 toward funeral and travel expenses.
Pennsylvania is the first state to try something similar. Living donors and families of dead donors get up to $300 toward lodging during the donation, but nothing for the funeral. The AMA plan would apply only to dead donors.
Because the money goes strictly for travel and lodging, Pennsylvania didn't need a federal waiver for the project.
Money for the program comes from a box people can check on their income tax form, McGarvey said. Almost six months into the program, 19 families have taken advantage of it, he said.
Dr. Richard McGarvey, who works at the Pennsylvania Department of Public Health, said increasing organ donations was only part of the goal. "Much of our goal was to say thank you to the family," he said.
And that's exactly how Englewood mom Kelly Snyder would have understood the offer seven years ago when her husband's truck was hit on Interstate 25.
Greg Snyder was in the hospital for three days before doctors told his wife he was brain-dead. His heart went to a Greeley man with whom Kelly Snyder still keeps in touch.
"When you're in that situation, there really is no bonus to anything," she said. "But it may be an extra incentive for someone to sign up to be an organ donor. . . . Everyone thinks it's such a touchy subject, but $500? It's not going to make you decide one way or the other."
Denver psychiatrist Jeremy Lazarus, who heads Colorado's AMA delegation, points out that money routinely is given to donors of plasma, and in some cases blood.
"When the balance is between life and death, most people choose life," he said. But after hearing both sides at this week's meeting, "I may change my mind."
Allison Sherry can be reached at firstname.lastname@example.org